Question
I've had TOS for over 10 yrs, managed quite well with relatively few chiropractic adjustments. Last feb. out of the blue 2 lower ribs (mid back) popped out and the left side twisted up under my shoulder blade. This triggered severe flareups of TOS symptoms, even on the right side, which was unusual for me. Despite adjustments, the lower ribs will not stay in place. Since I am having a lot of different neurological symptoms (at times severe vertigo, various pain in head) an MRI was done on my cervical vertebrate, and a consult with a neurosurgeon. Tho there is quite a bit of damage to the cervical vertebrates, he was quite adamant that the symptoms I was having were not related, and felt it was probably from the TOS. It is now Oct. and after a chiropractic treatment if I do much of anything the lower ribs pop out again. My chiropractor has no advice other that continually putting them back in when needed. He is perplexed. When the lower ribs move they slam against my spine and have dislocated the corresponding vertebrate. I'm assuming that part of my head symptoms are related to that from what I've experienced. The only suggestions I've had from MD's is physical therapy (with warnings to be careful about finding one familiar with TOS and not to let them touch my cervical area) but we are over an hour from any town and I cannot imagine getting enough benefit in relationship to the agony of the drive. Any thoughts?

Answer
Dear Tina,

It is impossible to diagnose and treat through the internet, but here are some thoughts that I have had after reading your data.

First of all, thoracic outlet syndrome is typically associated with symptoms into the arm and hand, in the form of pain and numbness and tingling. Have you been experiencing any pain, numbness, tingling sensations in one or both of your arms and hands?  If you do, are the symptoms in the arms and hands worse when you bend your neck backwards, looking up and the ceiling?

Second, often lower cervical spine pain is referred into the area between the shoulder blades.  It appears that you have some "issues" in the neck... so it is not above consideration that if you are experiencing medial scapular pain (pain along the inside area of the shoulder blade), that it could be related to lower cervical spine degenerative issues.

If you are having symptoms related to a lower cervical spine disc or degenerative spinal issue, you might respond to cervical traction therapy.  This will not make you grow new cervical spine joints, but it often times can help by decreasing the irritation on the lower cervical spine nerve roots.

Rib heads don't actually "go out of place", and the spine is not "dislocated" by a rib.  What actually happens is that muscles will spasm, they will cause rib head fixation, which causes pain, or the thoracic spine fixates or looses motion, the ribs are affected, and then this causes muscle spasm.  Of course, like I said above, none of this could be the cause of your pain, since lower neck troubles can cause upper mid back pain and pain between the shoulder blades.

I know that this is confusing. If you feel that you are not gettting results with your current Chiropractor and/or MD, try another chiropractor or MD.  It is nothing personal. A different doctor might give you a whole new perspective.

Good luck,

Keith Biggs, DC
http://www.eastmesachiropractor.com
http://www.arrowheadhealth.com